| Second Fruit Wellness Services Llc | |
|
2800 E Evergreen Blvd Ste B Vancouver WA 98661-4934 | |
| (503) 893-5931 | |
| Not Available |
| Full Name | Second Fruit Wellness Services Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2800 E Evergreen Blvd Ste B, Vancouver, Washington |
| Authorized Official Name and Position | Tiffany Aisha Edwards (OWNER) |
| Authorized Official Contact | 5038935931 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Second Fruit Wellness Services Llc 2800 E Evergreen Blvd Ste B Vancouver WA 98661-4934 Ph: () - | Second Fruit Wellness Services Llc 2800 E Evergreen Blvd Ste B Vancouver WA 98661-4934 Ph: (503) 893-5931 |
| NPI Number | 1326663311 |
|---|---|
| Provider Enumeration Date | 06/15/2020 |
| Last Update Date | 06/15/2020 |
| Certification Date | 06/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326663311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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